Modern Pediatrics. Ukraine

Pancreatic enzymes in the focus of therapy: contemporary strategies for managing exocrine pancreatic insufficiency

О.S. Nyankovska — 2025-09-28

Exocrine pancreatic insufficiency (EPI) is a common clinical condition in both children and adults, characterized by malabsorption, nutritional deficiencies, and reduced quality of life.

The aim - to review modern approaches to diagnosis and enzyme replacement therapy for EPI.

In pediatric practice, the leading causes of EPI include cystic fibrosis, chronic pancreatitis, congenital genetic syndromes, celiac disease, and postoperative conditions involving the gastrointestinal tract. Early diagnosis is based on clinical symptoms, laboratory markers (particularly fecal elastase-1), and comprehensive nutritional assessment.

Pancreatic enzyme replacement therapy (PERT) remains the cornerstone of EPI management. Its effectiveness depends on individualized dosing, timing of enzyme intake, and appropriate dietary support. In cases of persistent symptoms despite PERT, it is essential to evaluate dosage adequacy, administration regimen, and the presence of comorbid gastrointestinal disorders.

This article summarizes current European and North American guidelines on PERT use in children, offering practical recommendations for clinicians.

No conflict of interest was declared by the authors.

The impact of probiotics on immune response formation and the course of allergic diseases in children: the role Lactobacillus rhamnosus GG

T.R. Umanets — 2025-09-28

The aim of the study is to present an overview of current data on the influence of microbiota on the formation of the immune response and the importance of probiotics in the prevention and treatment of allergic diseases in children.

Over the past decades, the prevalence of allergic diseases (AD) has been rapidly increasing, especially in low- and middle-income countries. Recent studies indicate an important role of microbiota in the development of AD. The “microbiome” or “biodiversity” theory of the occurrence of AD is based on the idea that the composition and diversity of the human microbiota, especially the intestinal one, are crucial for the formation of the immune system and tolerance to allergens. Probiotics are live beneficial microorganisms that, when taken in adequate quantities, have a positive effect on human health, including supporting the immune system, anti-infective action, lowering cholesterol levels, improving nutrient absorption, etc. Lactobacillus rhamnosus is one of the most studied strains of probiotics with potential immunomodulatory function. LGG synthesizes a biofilm, which is a mechanical protection for the mucosa, reduces apoptosis of the intestinal epithelium, maintains the integrity of the cytoskeleton, and inhibits the growth of pathogenic microorganisms. LGG also promotes the differentiation of regulatory T cells (Treg) and reduces the activity of T-helper 2 cells, which play a central role in allergic inflammation. LGG is the most effective probiotic in the treatment and prevention of AD. Further studies of the immunomodulatory effects of different strains of probiotics are needed for a personalized approach in children at risk and with AD.

No conflict of interest was declared by the author.

Modern views on skin care in young children

Yu.V. Marushko — 2025-09-28

The article presents data on the anatomical and physiological characteristics of the skin of newborns, an analysis of the factors in the development of diaper dermatitis and the main measures aimed at its prevention and treatment.

Aim - to summarize the literature data on the use of modern infant skin care products from the standpoint of evidence-based medicine.

The skin of a child is a complex organ in its structure, performing many important functions in the body. The anatomical and physiological characteristics of the skin and errors in its care lead to the occurrence of typical skin lesions. The skin under the diaper is exposed to increased friction and hydration, has a higher pH and is repeatedly contaminated with feces, the enzymes of which have an irritating effect. As a result, diaper dermatitis can develop. Several factors are important in the development of diaper dermatitis, including long-term exposure to stool, changes in skin pH or increased hydration, as well as changes in the skin microflora. The most important aspects of diaper area hygiene is adequate skin care, which can prevent diaper dermatitis and speed up the healing of affected areas. It includes frequent diaper changes, aeration, gentle skin cleansing and the use of protective creams. Recently, more and more advanced means of protecting the baby's skin have appeared - improved diaper design and the development of wet wipes in compliance with all dermatological requirements. For the purpose of cleaning, it is suggested to use «Smile Baby» wet wipes with chamomile and aloe extract with a vitamin complex from the first days of birth, which provide anti-inflammatory and moisturizing effects.

The authors declare no conflict of interest.

The impact of physical activity on the health and quality of life of adolescents aged 14-15

M.O. Nosko — 2025-09-28

Physical activity is a leading factor affecting the health and quality of life of 14-15-year-old adolescents. Physical activity of 14-15-year-old adolescents is any body movement made by skeletal muscles, as a result of which there is a significant increase in the energy expenditure of the child's body. A sufficient level of physical activity increases the potential for the health level of children of older adolescence. At the same time, it is a necessary prerequisite for the harmonious development of adolescents and contributes to the preservation of health and the prevention of diseases.

Aim: to conduct a systematic analysis of scientific sources on the impact of motor activity on the health and quality of life of 14-15-year-old adolescents.

The basis of physical activity is physical exercises, and it is implemented in the process of physical education in secondary education institutions. The positive results of physical activity for improving the quality of life of 14-15-year-old adolescents are increased blood pressure, improved elasticity of capillaries, improved functioning of the heart as a muscular organ, increased blood flow, and accelerated metabolism in the body. Systematic motor activity activates the neuromuscular system, increases the child's performance in the educational process, helps improve blood circulation, and stimulates the work of internal organs. At the present stage, the implementation of the required level of motor activity is the key to the normal development of the body of 14-15-year-old adolescents. Modern scientific research substantiates the need for motivation, which affects motor activity and motivation to perform physical exercises.

It is necessary to promote various forms of motor activity for 14-15-year-old adolescents. Medical workers, physical education teachers, social workers, and teachers should conduct explanatory work on the positive impact of motor activity on the health and quality of life of 14-15-year-old adolescents.

The authors declare no conflicts of interest.

Youth-friendly clinics - components of the strategy of adolescent health care during the war

H.M. Danylenko — 2025-09-28

Negative national and world trends in medical, psychological and social indicators of children’s health indicate the need to improve the system of organization of medical care for adolescents, especially in times of social crisis. During the period of military operations, the experience of Youth Friendly Clinics (YFC) in our country and abroad, taking into account the information materials of WHO and UNICEF on medical care for adolescents, is relevant for the development of strategies and tactics of health-saving technologies for adolescents in a humanitarian crisis.

Аim - is the analysis of the strategy and prospects for providing comprehensive medical and social services to adolescents in the world and in Ukraine in the context of a humanitarian crisis, based on a summary of the experience of the YFCs during military operations.

Analysis of WHO and UNICEF information materials on medical care for adolescents, domestic and foreign scientific publications, reports of the YFCs to the Department of organizational and methodological work and quality control of medical care provision of the State Non-Commercial Enterprise «National Children's Specialized Hospital «Okhmatdyt» of the Ministry of Health of Ukraine». As of January 01, 2024, there were 42 YFCs in Ukraine including 3 centers, 7 departments, and 32 offices. The total number of appeals in 2024 was 56435. Compared to the pre-war period (2018), the number of YFCs decreased threefold, with a corresponding decrease in the number of visits. The necessary medical and social assistance is provided by specially trained personnel. The frequency of visits for illnesses or consultations in peacetime and wartime has not changed (50/50), but the need for psychological assistance has increased by almost 1.5 times in the structure of visits, so in 2018 56% of adolescents received it, and in 2024 - 78%.

Conclusions. Providing medical, psychological and social assistance in YFCs remains a relevant global trend and an effective tool for medical and preventive measures to preserve the health of adolescents and young people. In crisis situations in society, it is advisable to use the principles of the "friendly approach", the experience of YFCs. This indicates the need to improve the system of organizing medical support for adolescents, taking into account the experience of YFCs.

No conflict of interests was declared by the authors.

Motor actions in the process of forming motor activity of adolescents aged 15-16

B.A. Maksymchuk — 2025-09-28

Aim - to conduct a theoretical analysis of scientific sources that analyze the need for motor actions in the process of forming the motor activity of adolescents aged 15-16.

Physical activity is the basis of physical health and a component of a healthy lifestyle for adolescents aged 15-16. It ensures the development of physical qualities and strengthens the health of children. Physical activity allows you to resist stress and helps to transfer energy into a positive form of activity. Physical exercise and adherence to the correct physical and hygienic regime in adolescence are means of preventing diseases. Physical activity of adolescents aged 15-16 is any body movement made by skeletal muscles. The result of physical activity and motor actions is an increase in the energy expenditure of the adolescent’s body. The basis of physical activity is motor actions, physical exercises in the process of physical education in secondary education institutions. Pediatricians emphasize the positive results of physical activity, which improve the quality of life of adolescents aged 15-16 (increased blood pressure, improved capillary elasticity, improved heart function as a muscular organ, etc.). The implementation of the required level of motor actions and motor activity is the key to the normal development of the body of adolescents aged 15-16. Our scientists substantiate the need for motor activity in adolescents as the basis of physical health. Modern scientific research emphasizes the need for motor actions in the process of forming the motor activity of adolescents aged 15-16.

There is a need to promote various motor actions in the process of forming the motor activity of adolescents aged 15-16.

The authors declare the absence of a conflict of interest.

Masks of self-limited focal epilepsy of childhood (clinical observation)

D.I. Brytanchuk — 2025-09-28

Diagnosis of self-limited focal epilepsies is difficult due to the no specificity of symptoms. The diagnostic search strategy can be supplemented with video recording of unusual behavioural patterns/seizures, as well as a full-fledged night EEG with video recording.

Aim - to reveal the complexity of early diagnosis and variability of the clinical picture of self-limited focal epilepsy of childhood.

Clinical case. The history of the disease of a 5-year-old boy is presented, who was observed for complaints of periodic vomiting at night (1-3 times per night), that was not accompanied by awakening. The dynamics of clinical manifestations and results of additional examination were analyzed.

Conclusion. Reccurent vomiting in children requires broad differential diagnosis, which should include gastrointestinal pathology, structural brain abnormalities or tumors, cyclic vomiting syndrome, and self-limited childhood epilepsies. To confirm the latter diagnosis, an overnight EEG with video monitoring of seizures is necessary.

A rare case of neonatal pneumonitis with de novo mutation of surfactant protein (SFTPC)

V.L. Horova — 2025-09-28

Interstitial diseases of the respiratory system in children of the first two years of life remain an important medical and social problem due to the multifaceted clinical forms, the complexity of early diagnosis, and the severe course.

Aim - to provide information on the ways of timely diagnosis of neonatal pneumonitis.

Clinical case. The history of the disease of a boy I. aged 3 months with a clinic of severe respiratory failure is presented. The dynamics of clinical manifestations and the results of additional examination are analyzed. Since birth, muscle hypotension, poor sucking, and insufficient weight gain have been noted. X-ray of the chest organs did not reveal any changes. Computed tomography (CT) of the chest organs revealed signs of bilateral pneumonia of the “ground glass” type. A positive PCR result for metapneumovirus was obtained. Neonatal screening, 3B-EXOME (exome sequencing, PCR for respiratory pathogens, comprehensive immunological profile, bacteriological studies of blood and urine, bronchoscopy, ECG, EchoCG, CT scan of the brain, ultrasound of internal organs - no pathology. WES (whole-exome sequencing) revealed a heterozygous de novo mutation c.185A>C p.(Gln62Pro) in the SFTPC gene - a pathogenic variation that affects the BRICHOS domain of surfactant protein C. The diagnosis was confirmed at the age of 11 months. Tracheostomy was performed, CPAP (Continuous Positive Airway Pressure) therapy was prescribed, enteral feeding through a gastrostomy. Maintenance therapy was prescribed: hydroxychloroquine, azithromycin, amlodipine, inhalations. After 6 months - stable condition, without the need for CPAP, with oxygen supply 1 L/min. Vaccinated according to the extended schedule (PCV-20, MEN-B, RSV, MEN-ACWY, influenza).

Conclusion. Due to the ability to quickly establish the etiology of the disease, genetic analysis methods, namely WES or WGS, contribute to reducing the number of unnecessary examinations, shortening the length of hospital stay and ensuring the timely initiation of specific treatment.

Clinical case of early diagnosis of Hierke's disease

V.E. Kyseleva — 2025-09-28

Glucose-6-phosphatase deficiency (glycogen storage disease I, von Hierke's disease) refers to hereditary metabolic diseases (SHD), which often manifest in the neonatal period and have a rapidly progressive course, therefore often remain unrecognized, or are confirmed after the death of the child. today remains insufficient,

Aim - to increase the awareness of doctors about the manifestations and diagnosis of SHD.

Clinical case. The medical history of a 5-month-old child with a complaint of a seizure during an examination by a pediatrician in the outpatient department is provided. The child was hospitalized in the pediatric department, where a coronavirus infection was diagnosed according to the rapid test, then digestive system disorders in the form of vomiting, loose stools, and a decrease in the number of breastfeeds were added. From the anamnesis of life, it is known that an episode of hypoglycemia was noted on the first day after birth. Objectively, the child's condition is severe: lethargy, decreased appetite, periodic vomiting, a decrease in blood glucose levels to 1.9 mmol/l was recorded. The rapid development of metabolic acidosis (pH=7.0; HCO3=5.7 mmol/L), increased lactate dehydrogenase (LDH=9.1 U/L) and acute phase indices (C-reactive protein (CRP=26.7 mg/L), erythrocyte sedimentation rate (ESR=27 mm/h), procalcitonin (PCT=6.2 ng/L), leukocytosis (L=16.4 G/L), with a left shift of the formula, and hypokalemia (K=2.24 mmol/L) forced us to conduct a differential diagnosis between an infectious process complicated by the development of sepsis and SHO. The rapid positive dynamics during the correction of metabolic disorders and the same rapid regression after stopping the glucose infusion were in favor of SHO. A preliminary diagnosis of Hierke's disease was made, which was confirmed by genetic research.

Conclusion. Awareness of possible clinical manifestations of SHO, rapid coordinated actions at the time of development of metabolic crises and organization of the child's feeding regimen can contribute to their early diagnosis and save the lives of patients.

Primary antiphospholipid syndrome in childhood (individual observation)

M. Kochederia — 2025-09-28

Antiphospholipid syndrome (APS) in children is a rare but potentially lethal condition that can debut in the form of a catastrophic course (catastrophic antiphospholipid syndrome, CAPS), characterized by rapid progression of multiple thromboses and multi-organ involvment. This disease can be the first manifestation of APS, which making early diagnosis difficult.

Aim - to provide information on the clinical manifestations and course of primary antiphospholipid syndrome in childhood.

Clinical case. The clinical course and the results of additional examinations of a 16-year-old girl who was hospitalized in critical condition with multiple organ dysfunction were analyzed: cutaneous hemorrhagic syndrome, signs of central nervous system dysfunction (aphasia, nystagmus), deep vein thrombosis, pulmonary infiltrates, and oliguria. The first episode of the disease occurred in 2018, when, after the injury, inflammation of the soft tissues of the foot led to necrosis of the distal phalanges of the toes of the left foot and amputation. In 2023, acute ischemic cerebrovascular accident, severe hypermenorrhea and posthemorrhagic anemia, and acute thrombocytopenia were noted. The clinical diagnosis was: D68.8 - Primary antiphospholipid syndrome, catastrophic course. Complications: Deep vein thrombosis of the thigh, thrombosis/embolism of small branches of the pulmonary artery. Acute kidney injury, oliguric stage. History of ischemic stroke on 05/29/2023. Comorbidities: Excessive menstruation during puberty. Hypothalamic syndrome of puberty. Hypertensive disease (postthrombotic hypertensive syndrome). The first line of therapy was performed: nadroparin calcium and acetylsalicylic acid, pulse therapy with methylprednisolone, intravenous immunoglobulin (IVIG). Due to retrothrombosis, the second-line was initiated: cyclophosphamide and repeated infusion of IVIG [2]. Clinical stabilization was achieved, recanalization of thrombi. However, 2 months later, when attempting to switch anticoagulant therapy, the patient died from massive thromboembolism.

Conclusion. CAPS requires a high index of suspicion for differential diagnosis and diagnosis, as many patients (up to 50%) have CAPS as the first manifestation of APS. The negative outlook for the further course in 65-80% of patients, frequent relapses within 3-6 months and high mortality emphasize the need to study such clinical cases.

Irritable bowel syndrome in children: emphasis on microsocial risk factors and protection

M.O. Semen — 2025-09-28

Functional gastrointestinal disorders, in particular irritable bowel syndrome (IBS), are one of the most common reasons for referral to a pediatric gastroenterologist.

Aim - to determine microsocial risk factors for irritable bowel syndrome.

Materials and methods. The study involved 54 patients aged 6-12 years with a diagnosis of IBS established according to the Rome IV criteria, as well as 50 practically healthy children from the control group using "family history" (descriptive and phenomenological collection of life history from one of the patient's parents). For statistical analysis of the data obtained, Microsoft Excel and GraphPad Prism 5 programs were used. For the comparison of frequency indicators of independent groups, Pearson's Chi-square (χ²) test was used without Yates' correction for continuity. A p-value < 0.05 was considered statistically significant.

Results. In the group of children with IBS, the following family risk factors were identified: a tendency to somatization in the mother; frequency of visits to doctors by the child >6/year; frequency of visits to doctors by the mother >6/year; authoritarian parenting style by the mother, hyperprotective parenting style by the father, and a burdened history of other psychosomatic disorders. Children with IBS were more likely to have frequent overeating and food intolerances. Warm family relationships and a democratic parenting style on the part of both parents can be considered protective factors for the occurrence of IBS in a child.

Conclusion. Microsocial risk and protective factors have a significant impact on the formation of IBS in children.

Clinical case of cat scratch disease with abscesses of the kidneys, liver and spleen

Y.L. Stupin — 2025-09-28

Cat scratch disease (CSD) caused by Bartonella henselae is a benign, self-limiting disease with typical manifestations, including fever and regional lymphadenitis. However, in atypical forms, the microorganisms spread and infect the liver, spleen, eyes or central nervous system. It is important to recognize patients with disseminated disease to prevent life-threatening complications.

Aim - to present a case of disseminated CSD to improve diagnostic accuracy and prevent life-threatening complications.

Clinical case. We reviewed the medical history of a 14-year-old boy with a 15-day history of fever up to 39°C. The dynamics of clinical manifestations and the results of additional examination were analyzed.

Conclusion. In cases of unexplained prolonged fever, cat scratch disease should be considered in the differential diagnosis. Imaging studies are recommended to rule out visceral abscesses.

Children's population of a front-line city: new challenges

M.M. Cherkashin — 2025-09-28

The war in Ukraine led to an unprecedented process of migration and changes in the living conditions of millions of residents, including children. Today, there is no clear understanding of how the physical and mental state of the child population will change in response to modern war conditions, changes in living and learning conditions, migration, and deterioration of family health.

Aim - to assess the frequency of signs of risk of developing post-traumatic stress disorder (PTSD) among practically healthy children in the city of Kharkiv.

Materials and methods. The results of a survey of 814 children, residents of the city of Kharkiv until February 24, 2022), who were in Kharkiv, other regions of Ukraine and abroad at the time of the survey were analysed. The CATS 2 questionnaire (Child and Adolescent Trauma Screen, version 2) was used. An analysis of the frequency of symptoms and an estimate of the odds ratio (OR) was performed.

Results. PTSD symptoms occurred in 22.9% of children, without differences depending on gender, place of residence and were considered as moderate reaction (34.5%), increased distress (25.1%) and severe distress (40.5%). The frequency of severe reaction was significantly higher in children who had gone abroad and migrated to other regions of Ukraine compared to children in Kharkiv (p<0.05). The chances of developing PTSD were 4 times higher in those who experienced food or water shortages than in those who were separated from their and 3 times higher than in children who are/were witnesses of hostilities 40/71. When comparing the results over time since the beginning of the war, a negative dynamic of indicators was established in children living in Kharkiv, in contrast to children who migrated.

Conclusion. A high risk of developing mental disorders was established in children - pre-war residents of Kharkiv, regardless of their place of residence within 2-3 years from the beginning of the war.

A expedient choice in the treatment of acute upper respiratory tract infections in childhood

O.K. Koloskova — 2025-09-28

Acute tonsillopharyngitis is one of the main reasons for prescribing antibiotics to children. Inappropriate use of antibiotics in children often leads to the development of antibioticresistance.

Aim - to investigate the effectiveness and safety of the use "Coldysept nanoSilver throat spray" compared to standard therapy to optimize the treatment of acute tonsillopharyngitis in children.

Materials and methods. 80 patients aged 6 to 17 years with signs of acute respiratory infection of the upper respiratory tract were observed and divided into two groups. The main group consisted of 50 patients who received standard therapy with "Coldysept nanoSilver throat spray" for 7 days, the comparison group consisted of 30 patients who received standard therapy according to guidelines.

Results. The effectiveness of the "Coldysept nanoSilver throat spray" use in the therapy of children on the 3rd day was associated with a significantly better reduction of sore throat, difficulty swallowing and plaque on the tonsils. The frequency registration of the minimum score of acute process symptoms severity on the 5th day treatment demonstrates a similar prevalence of them in main group. On the 7th day of therapy, these symptoms were not observed in patients in the main group, while in children in the control group the symptoms persisted.

Conclusions. The obtained data of the dynamic comparative analysis of the use of “Coldisept nanoSilver throat spray” in the complex treatment of children with acute upper respiratory tract infections compared to standard tactics confirm that the proposed approach significantly accelerates recovery with good tolerability and safety of use.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the researches.

No conflict of interest was declared by the author.

Hypozincemia and Long COVID symptoms in children

O.R. Boyarchuk — 2025-09-28

Zinc plays a crucial role in the functioning of the immune system, and its deficiency may influence the risk of infection and the severity of infectious diseases.

Aim - to assess the role of hypozincemia in the development of Long COVID and its symptoms in children.

Materials and methods. A prospective cohort study included 127 children with confirmed COVID-19. Serum zinc levels were measured during the acute phase of the disease, and the occurrence of Long COVID symptoms was monitored for 12 months.

Results. Zinc deficiency was detected in 25,2% of children. Long COVID symptoms were recorded in 42,5% of patients, but no statistically significant correlation was found between zinc levels and the development of Long COVID. The most common symptoms were fatigue (46,3%), neurological disorders (27,8%), gastrointestinal symptoms (14,8%), and cardiovascular manifestations (5,6%). Fatigue was observed 1,7 times more frequently, and neurological symptoms 2,2 times more frequently in children with zinc deficiency compared to those with normal zinc levels, but the differences were not statistically significant.

Conclusions. This study did not identify a significant impact of hypozincemia on the development of Long COVID and its symptoms in children. However, the findings highlight the need for further large-scale studies on the role of micronutrients in post-COVID recovery, the influence of nutritional status on post-COVID complications, and the potential benefits of zinc supplementation in COVID-19 patients.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Bioethics Committee of the mentioned institution. Informed consent was obtained from all participants.

The authors declare no conflict of interest.

Features of hepatocellular and biliary senescence in pediatric autoimmune and primary sclerosing cholangitis

M.B. Dyba — 2025-09-28

Cellular senescence is considered one of the key mechanisms driving fibrosis progression in immune-mediated cholangiopathies. The markers p16^INK4a and p21^WAF1/Cip1 reflect the senescent phenotype; however, data on their expression in children with autoimmune sclerosing cholangitis (ASC) and primary sclerosing cholangitis (PSC) are lacking.

Aim - to evaluate the expression of p16^INK4a and p21^WAF1/Cip1 in liver biopsies of children with ASC and PSC and to determine their pathogenetic and diagnostic significance.

Materials and methods. Twenty-seven liver biopsies from children aged 4-18 years (18 with ASC, 9 with PSC) were analyzed. Morphological changes and fibrosis stage were assessed according to the Nakanuma classification. Immunohistochemistry for p16^INK4a and p21^WAF1/Cip1 was performed in cholangiocytes and hepatocytes to detect cellular senescence.

Results. p16^INK4a expression in cholangiocytes was frequent in both ASC (77.8%) and PSC (88.9%). Senescent cholangiocytes with p16^INK4a expression were already present at early disease stages, confirming the early development of the biliary senescence phenotype. p21^WAF1/Cip1 expression in cholangiocytes was rare (16.7% and 11.1%, respectively). In hepatocytes, expression of p16^INK4a (83.3% vs 22.2%) and p21^WAF1/Cip1 (66.7% vs 11.1%) was significantly more frequent in ASC than in PSC.

Conclusions. In most children with ASC and PSC, p16^INK4a-positive cholangiocytes were detected, confirming the biliary senescence phenotype as a key pathogenetic feature. ASC was additionally characterized by the coexistence of hepatocellular and biliary senescence phenotypes, which may contribute to faster fibrosis progression. Expression of p16^INK4a and p21^WAF1/Cip1 in hepatocytes and cholangiocytes may serve as a potential morphological biomarker of severe disease course and as a promising target for novel therapeutic strategies.

The study complied with the principles of the Declaration of Helsinki and was approved by the institutional ethics committee. Informed consent was obtained from the patients prior to participation.

The authors declare no conflict of interest.

Determination of alpha-defensin levels in dynamics in newborns with sepsis

N.T. Kerimova — 2025-09-28

Aim - to investigate some pathogenetic mechanisms of immune system changes during sepsis in premature and full-term infants by determining the levels of alpha-defensin.

Materials and methods. A total of 130 newborns were examined. Of these, 100 were infants undergoing inpatient treatment with a diagnosis of sepsis (early and late), and 30 were healthy newborns. The children participating in the study were divided into the following groups: Group I - full-term newborns diagnosed with sepsis, gestational age 38-41 weeks (n=35); Group II - premature newborns diagnosed with sepsis, gestational age 27-37 weeks (n=65); Control group: healthy newborns (n=30), of which 23 were born full-term and 7 were premature. The determination of alpha-defensin was carried out using a standard solid-phase ("sandwich " version) enzyme-linked immunosorbent assay. The statistical processing of the obtained data was carried out using the Wilkinson U-test.

Results. In full-term infants diagnosed with sepsis, α-defensin in the first days of the disease was 771.8±37.6 ng/ml and was significantly different from the results in the control group (p<0.001). Over time, this indicator decreased as a manifestation of the weakening of the inflammatory process and was 380.0±21.1 ng/ml. Similar dynamics of α-defensin (727.9±27.2 ng/ml and 363.2±14.5 ng/ml, respectively) were observed in premature infants. Statistically significant increase was observed in both early and late sepsis (716.7±53.3 ng/ml and 731.3±31.8 ng/ml, respectively). High values were the result of the manifestation of inflammation in both forms in the first days. With repeated measurements (re-check), this indicator decreased to a greater extent in children with early sepsis; this difference corresponded to the previous indicators (1.487±0.034 EU/ml and 0.987±0.110 EU/ml, respectively)

Conclusions. Based on the results of the study, it can be said that alpha-defensin in full-term and premature septic infants can be used as an additional criterion for characterizing the immune status and inflammatory process in sepsis, predicting outcomes, and assessing the degree of immunodeficiency.

Features of the course of Crohn's disease in young children

T.L. Marushko — 2025-09-28

Over the past decades, the incidence of Crohn’s disease (CD) among young children has been steadily increasing worldwide. The complexity of managing such patients is due both to the severe and treatment-resistant course of the disease and to the specific features of its intestinal and extraintestinal manifestations.

Aim - to determine the clinical and paraclinical features of the course, the frequency and structure of extraintestinal manifestations, and the role of psychosomatic triggers in the initiation and severity of Crohn’s disease in young children at the present stage.

Materials and methods. 17 children from 0 to 3 years of age with CD were examined. Clinical-anamnestic, laboratory, ultrasound, endoscopic, and pathomorphological research methods were used.

Results. In the vast majority of children, the course of CD was severe (64.7%) or moderate (35.3%), with involvement of all segments of the intestine. Follow-up during treatment showed insufficient effectiveness of protocol corticosteroid therapy in 47.1% of patients. At the early stage of the disease, only 23.5% of the examined patients had clear clinical, laboratory, endoscopic, and morphological signs of CD; therefore, in most cases, the initial diagnosis was Unclassified form of Inflammatory Bowel Disease (IBD-U), which complicated the choice of treatment strategy and the monitoring of its effectiveness. More than 90% of young children with CD had extraintestinal manifestations and complications, including 58.8% of patients with three or more extraintestinal manifestations. The most common among them were anemia, protein-energy malnutrition, and growth retardation. The most frequent external triggers of CD in early childhood were severe respiratory and intestinal infections, coronavirus infection, and food allergy, on the background of genetic predisposition.

Conclusions. In most young children, CD is characterized by high inflammatory activity and involvement of all segments of the intestine in the pathological process. Children with IBD-U require regular examinations to clarify the nosological form of IBD as quickly as possible. The high frequency of extraintestinal manifestations of CD in young children confirms the need for medical management involving a multidisciplinary team of specialists.

The authors declare no conflict of interest.

Optimization of therapeutic and preventive measures in children with disorders of teeth formation

S.F. Liubarets — 2025-09-28

The results of existing studies on mineral metabolism and its impact on the development of dental caries as a complication of disorders of teeth formation in children are ambiguous and require in depth study.

Aim - to develop and evaluate the effectiveness of complexes of therapeutic and preventive measures aimed at preventing complications against the background of disorders of teeth formation in children, taking into account the mineralizing potential of the oral fluid.

Materials and methods. The study object is 289 children. The average age of the survey is 8.75±6.37 years. Two complexes of therapeutic and preventive measures have been developed with the inclusion of remineralizing drugs. Application - 2 years. Caries intensity was evaluated in accordance with the recommendations of the WHO Experts Committee (2013), taking into account «decayed, filled» (df) for temporary teeth, «decayed, missing, and filled» (DMF) for permanent teeth (df + DMF for mixed bite). The laboratory examination included the determination of the concentration of total calcium and phosphates in the oral fluid. Statistical data processing was performed using variational statistics methods.

Results. The complex of therapeutic and prophylactic measures with the inclusion of a water-based remineralizing row, which contains casein phosphopeptide-amorphic calcium phosphate has proved more effective. Two years after its introduction, the content of calcium in the oral fluid of children of all groups increased and was in the range from 1.17±0.11 to 1.48±0.15 mg/l, the level of phosphates also increased - from 3.37±0.16 to 4.08±0.46 mg/l; the intensity of dental caries in groups of individuals with systemic enamel hypoplasia, both with and without somatic pathology, as well as in children with molar-incisor enamel hypomineralization, not burdened by somatic pathology, was significantly lower compared to baseline indicators.

Conclusions. In order to prevent complications, including dental caries in children with disorders of teeth formation, two complexes of therapeutic and preventive measures were proposed, the effectiveness of which was evaluated in dynamics within 12-24 months. Carrying out preventive measures increased the level of mineral components of oral fluid and led to a decrease in the intensity of dental caries in children with disorders of teeth formation, which was more pronounced when using a complex with the inclusion of a water-based remineralizing cream containing casein phosphopeptide-amorphous calcium phosphate.

The author declares no conflict of interest.

Comparison of the effectiveness of treatment of acute phlegmonous appendicitis and its complications in children using laparoscopic technologies depending on the technical generation of the equipment

O.O. Lozytskyi — 2025-09-28

Acute appendicitis has been and remains the most common pathology in emergency pediatric surgery. Treatment technologies are constantly improving, but the availability of different generations of laparoscopic equipment in medical facilities requires the development of recommendations for use.

Аim - to evaluate the effectiveness and safety of laparoscopic interventions among children with acute phlegmonous appendicitis and its complications, performed using laparoscopic equipment of different technological generations (first and second generations of minimally invasive equipment) by analyzing key clinical, intraoperative, and postoperative indicators.

Materials and methods. The analysis covered 61 cases of children diagnosed with acute phlegmonous appendicitis who underwent laparoscopic appendectomy between 2015 and 2023. The patients were divided into two groups: I - 33 children who underwent surgery using first-generation laparoscopic equipment (with analog imaging and instruments with limited functionality) (archival data from medical records for 2015-2017); II - 29 children who underwent surgery using second-generation laparoscopic equipment (with digital imaging and instruments with an expanded range of capabilities) (archival data from medical records for 2022-2023). To evaluate the effectiveness of treatment, an analysis of clinical and laboratory indicators was performed, including the duration of surgery, length of hospital stays, number of medications required for infusion and symptomatic therapy, and number and duration of antibiotic treatments.

Results. Comparing the treatment results, the following can be noted for patients in the group II: the duration of surgery was shorter; required less infusion therapy; had a shorter hospital stay; normalization of blood laboratory parameters occurred faster, despite the shorter hospital stay.

Conclusions. The results of surgical treatment are directly dependent on the technical generation of equipment. Considering the heterogeneity of medical equipment in Ukrainian medical institutions, the question of choosing a treatment method and tactics depending on the technical generation of equipment remains relevant.

No conflict of interest was declared by the authors.

Optimization of scientific research of theoretical and methodological foundations of the formation of a culture of personal health

A.S. Sverstyuk — 2025-09-28

Aim: to optimize the scientific search for theoretical and methodological foundations of personal health culture formation by conducting a comprehensive bibliometric analysis in the Scopus database.

Materials and methods. To achieve this goal, the bibliometric analysis of publications in the Scopus scientometric database was used. An analytical query was formed with keywords reflecting the concepts of ‘culture of personal health’, ‘theoretical and methodological foundations’, ‘health care’, etc. Quantitative indicators (dynamics of publications, distribution by industry, geography, and authors) and bibliometric metrics (CiteScore, SIR, SNIP) were selected and analyzed.

Results. 828 scientific publications were identified, 538 of which were published in the last decade, which indicates the actualisation of the problem of health culture formation in the modern scientific space. Most researches are related to the medical field, social sciences, and engineering, which emphasises the interdisciplinary nature of the topic. The leading countries in terms of the number of publications are the United States, the United Kingdom, Australia, Canada, and China. The largest number of sources falls on recent years, which reflects the growing interest in health promotion, in particular, in the context of global challenges.

Conclusions. The results of the study confirm the growing attention to the formation of a culture of personal health as an important component of preventive medicine, education, and social initiatives. The identified trend towards the integration of various fields of knowledge opens up additional prospects for the development of comprehensive methods and strategies in the field of health promotion. In the future, it is advisable to carry out an in-depth analysis of the qualitative aspects of publications, as well as to develop scientifically sound recommendations for the implementation of appropriate approaches in practice.

No conflict of interest was declared by the authors.

Congenital sucrase-isomaltase deficiency (clinical case)

V.S. Berezenko — 2025-09-28

Congenital sucrase-isomaltase deficiency (CSID) is a fermentopathy, the frequency of which reaches 10% among patients with gastrointestinal symptoms. As a result of mutations in the gene responsible for the synthesis of sucrase and isomaltase enzymes, the activity of these enzymes is disrupted, which leads to a violation of the breakdown of sucrose and starch in the lumen of the small intestine. The accumulation of undigested carbohydrates in the intestines is the cause of osmotic diarrhea, and their fermentation by colon bacteria leads to the release of large amounts of hydrogen and other gases, which is accompanied by significant bloating and flatulence. The main methods for diagnosing pathology are breath tests and genetic studies, and the main approaches in management are replacement therapy with sucrosidase and diet therapy with the exclusion of food sources of sucrose and starch.

Aim - to highlight the current knowledge about CSID and the possibility of differential diagnosis of this pathology based on a clinical case.

The article presents a clinical case of a 5-year-old child who was hospitalized with symptoms of abdominal discomfort, flatulence, bloating, watery diarrhea, impaired physical and psychomotor development, thrombocytopenia and a decrease in pancreatic elastase-1. In the process of examining the child (analysis of complaints and anamnestic data, physical and laboratory-instrumental examination, genetic testing), the diagnosis of CSID was verified. Against the background of the prescribed diet therapy, the general condition of the patient improved, the growth rate normalized and the weight index improved significantly, the gastrointestinal symptoms disappeared, the frequency and consistency of stools, as well as the index of pancreatic elastase-1, were normalized.

Conclusions. CSID is enzymopathy that occurs in 10% of patients with gastrointestinal symptoms. Due to the similarity of its typical clinical manifestations to the symptoms of a number of other pathological conditions, such as irritable bowel syndrome, inflammatory bowel disease, small intestine bacterial overgrowth syndrome, gluten-dependent diseases, as well as other enzymopathies, its diagnosis is often difficult and untimely. Awareness of pediatricians, gastroenterologists and family doctors in features of the course of the disease, instrumental diagnosis, differential diagnosis and management of CSID are the key to timely diagnosis and successful treatment of such patients.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Food protein induced proctocolitis syndrome in infants (clinical case)

T.O. Kryuchko — 2025-09-28

Food protein-induced allergic proctocolitis is a transient cell-mediated inflammatory disease of the colon that manifests as haemocolitis, often accompanied by mucous streaked faeces. This allergopathology is determined on the basis of the disappearance of symptoms after the exclusion of a food allergen, most often cow's milk protein, from the child's diet.

Аim - to report a clinical case of proctocolitis syndrome induced by food proteins, as well as to conduct a modern analysis of the main aspects of diagnosis, differential diagnosis and management of this disease.

The article presents a clinical observation of a child of infancy, who had progression of the disease due to non-compliance with elimination therapy therapy and dietary disorders on the part of both the mother and the child due to continued consumption of dairy products. The main aspects of timely verification, differential diagnosis and management of this allergopathology are also considered, despite the low prevalence of the disease, which emphasises the relevance of early detection and a comprehensive approach to treatment, taking into account modern international recommendations.

Conclusions. Food protein-induced allergic proctocolitis is an important problem in paediatric gastroenterology, particularly at the primary care stage, which requires a correct and timely approach to patient management. Effective treatment and monitoring is possible only with close cooperation between paediatricians, general practitioners, gastroenterologists and allergists.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all participants.

The authors declare no conflict of interest.

Immune thrombocytopenia and systemic lymphoproliferative syndrome as primary clinical manifestations of combined immunodeficiency associated with CTLA-4 deficiency

O.I. Dorosh — 2025-09-28

Severe combined immunodeficiency (SCID) associated with CTLA-4 deficiency is a rare serious genetic immunological disorder caused by mutations in the CTLA-4 gene. A characteristic feature of this immunodeficiency is systemic lymphoproliferative syndrome (LPS), infiltration of internal organs by lymphoid cells and autoimmune cytopenias, among which immune thrombocytopenia (ITP) may be the first or even the sole clinical manifestation in the early stages of the disease, which significantly complicates diagnosis. The disease often presents itself in childhood or adolescence. The wide variability of phenotypic manifestations in patients significantly complicates and delays the diagnostic process.

Aim - to describe a clinical case of SCID associated with CTLA-4 deficiency with a combination of ITP and systemic LPS.

Clinical case. A 1,5-year-old girl with progressive systemic lymphadenopathy, hepatosplenomegaly, thrombocytopenia, frequent infections from an early age was found to have decreased IgA, IgM, IgG, B-memory cells, the presence of ANA antibodies, and a positive direct Coombs test. Genetic testing confirmed the presence of pathogenic variants in the genes: CTLA-4 (with autosomal dominant CTLA-4 deficiency - immune dysregulation, autoimmunity, lymphoproliferation) and CORO1A (autosomal recessive severe combined immunodeficiency).

Conclusions. The initial manifestations of SCID are often nonspecific, which can delay the final diagnosis. The combination of LPS and ITP in childhood should be considered a potential manifestation of primary immunodeficiency. CTLA-4-SCID is a rare clinical case that requires increased oncological and immunological vigilance. Early detection of CTLA-4 deficiency through immunological and molecular genetic diagnosis is critical for timely treatment and prevention of serious complications. Іt is important that physicians of various specialties consider congenital immunodeficiencies among the possible causes during the differential diagnosis diseases.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Mediastinal hemangioma and aortic coarctation - a rare combination (a clinical case)

A.A. Malska — 2025-09-28

Coarctation of the aorta (CoA) is a congenital heart defect characterized by narrowing of the aortic lumen, most often in the region of the isthmus, leading to impaired systemic blood flow. Hemangioma is a benign vascular tumor that occurs in about 10% of infants, more frequently in girls. In most cases, they are asymptomatic; however, when large, they may compress adjacent structures such as the aorta or airways, leading to hemodynamic compromise or respiratory disorders.

Aim - to present a clinical case of a rare combination of a cutaneous hemangioma of the chest wall, a mediastinal hemangioma, and coarctation of the aorta in a one-month-old infant, highlighting the diagnostic and therapeutic challenges.

Clinical case. A one-month-old infant, born at 35 weeks of gestation as the second of twins conceived via in vitro fertilization, was noted to have a large hemangioma on the anterior chest wall. Before initiating beta-blocker therapy, the child was referred to a cardiologist, and echocardiography revealed coarctation of the aorta with a high pressure gradient. Computed tomography of the chest revealed a massive mediastinal vascular tumor extending to major vessels, which precluded radical surgical repair of the heart defect due to the high risk of massive intraoperative bleeding. Under these circumstances, balloon angioplasty was performed, resulting in partial reduction of the pressure gradient, after which beta-blocker therapy was initiated, with the plan for radical correction following hemangioma regression.

Conclusions. In our case, the chest wall hemangioma prompted extended diagnostic evaluation, which enabled timely identification of not only the mediastinal tumor but also coarctation of the aorta. This emphasizes the importance of comprehensive evaluation of children with hemangiomas to rule out associated vascular anomalies, including aortic arch involvement and PHACES syndrome.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from participant.

The authors declare no conflict of interest.

Diagnostic and management challenges of primary ciliary dyskinesia in children: analysis of a clinical case

O.O. Starets — 2025-09-28

Primary ciliary dyskinesia (PCD) is a rare genetic disorder of mucociliary clearance, typically presenting with persistent airway infections and ENT comorbidities, and is frequently underdiagnosed in the absence of situs inversus.

Aim - to highlight diagnostic and management challenges through a case of adolescent-onset PCD without situs inversus.

Clinical case. A 17-year-old female had neonatal pneumonia requiring prolonged hospitalization; at age 3 she developed bacterial pneumonia with destruction of the right middle lobe followed by varicose bronchiectasis. Since early childhood she experienced recurrent lower/upper respiratory tract infections, otitis media with effusion, exacerbations of chronic rhinosinusitis, and productive cough. Сystic fibrosis was excluded, and primary immunodeficiency was not confirmed. Chest CT showed varicose bronchiectasis of the right middle lobe. Molecular testing (2019) identified compound-heterozygous RSPH4A variants (c.1068G>A p.Trp356*; c.1818dupC p.Trp607Leufs*36) and a VUS in CCDC103 (c.82C>T p.Arg28Trp). Management included hypertonic (3–5%) saline inhalations, daily airway clearance/physiotherapy, nasal irrigations, antibiotic therapy as indicated, and multidisciplinary follow-up (pediatrics, pulmonology, otolaryngology).

Conclusions. The constellation of persistent productive cough, early-onset recurrent lower/upper airway infections, right middle lobe bronchiectasis, and absence of situs inversus should prompt targeted screening for PCD with molecular confirmation. Early multidisciplinary care is crucial to mitigate disease progression.

The authors declare no conflict of interest.